First and final year physiotherapy students’ expectations of their future profession

ABSTRACT

Background and Aim

Students’ expectations of their future profession may have an impact on their professional development. This study aimed to describe first and final year physiotherapy students’ expectations of their future profession.

Methods

A total of 96 respondents participated; 45 students in their first semester 2006, and 51 students in their final semester 2014. Individual written reflections were analyzed separately for each semester, using qualitative manifest inductive content analysis.

Results

The analysis resulted in six categories from each semester. The categories from the first semester were: 1) Professional and person-centered; 2) Promote health in a holistic way; 3) Competence makes the patient and therapist feel confident; 4) Focus on education and behavioral change; 5) Confirmed as a role model; and 6) The impact of previous experiences and an unknown situation. The categories from the final semester were: 1) Interaction and learning; 2) Confidence by competence; 3) Value the work environment and knowledge exchange; 4) Personal goals and strategies; 5) Specialist or generalist work; and 6) Work with public health in a global world.

Conclusions

In the first semester, students described different work approaches, while students in the last semester described how approaches were to be used. Furthermore, students in their first semester referred more to previous experiences, while students in their final semester developed strategies to achieve their professional goals. These findings might contribute to guide students' in their continuous professional development based on their experiences and expectations.

KEYWORDS:

• Education
• professional competence
• professional development
• professional identity
• qualitative content analysis
• reflections

Introduction

The international goals of physiotherapy education are life-long learning and professional development, which includes evidence-based practice and professional skills that address different needs in a variety of settings (World Physiotherapy, 2019). The future of physiotherapy addresses prevention, promotion, and wellness within various sectors of society, in clinics, schools, and commercial premises (World Physiotherapy, 2011a). In Sweden as in several other countries, the physiotherapy profession is independent and regulated by a license to practice and laws and regulations (World Physiotherapy, 2011b). There is also direct access and self-referral to physiotherapy in many countries (World Physiotherapy, 2011b). Registered physiotherapists are responsible for their own professional development, and for the development of the profession, to meet changes in society (World Physiotherapy, 2022).

An aging population and increased calls for equal rights for people with disabilities raise the demands on physiotherapy competence in health care (Gotlib et al., 2012) which includes development within health care, such as new interventions and approaches (Fagerström, Tuvesson, Axelsson, and Nilsson, 2017). Therefore, it is important to support physiotherapy students in acquiring the competencies necessary to handle future changes in their work life. Educators must encourage each student’s professional development, both academic and clinical (Cowin, Johnson, Wilson, and Young, 2013; Heggen and Terum, 2013; World Physiotherapy, 2019).

Professional Development

To understand how students can be supported when entering the profession, ensuring they are ready to meet demands from health care, society, patients, and the international professional confederation, as well as future professional challenges, the conceptual framework described below was used to outline this process. This helped create a perspective of professional development from novice student to competent health care team member.

Professional competence is the ability to use knowledge, technical skills, clinical reasoning, reflection, communication, emotions, and values to serve the individual and the community (Epstein and Hundert, 2002). This is also the foundation of professionalism, which is the ability to apply specific skills in an uncertain, complex and unpredictable situation and advance the profession (Richardson, 1999). A base of knowledge and skills is needed to feel safe in the profession (Boström et al., 2013; Douglas and Gibson, 2003) and the knowledge base evolves with time via reflection and questioning (Trede, 2012).

Finally, professional identity is an understanding of one’s own professional role, as well as the norms and standards of the profession (Heggen and Terum, 2013). Educators facilitating students’ understanding of how to use professional skills helps students understand their professional identity (Richardson, 1999). Their professional identity develops during basic training and evolves throughout their professional life as a result of challenges in patient treatments (Gotlib et al., 2012) and positive and negative experiences of interprofessional and intraprofessional interactions (Trollope-Kumar and Wong, 2014). These factors in combination support a professional development in a life-long perspective.

Personal values and societal factors also affect professional identity (Cowin, Johnson, Wilson, and Young, 2013) and may influence one to change beliefs and adopt new skills (Cowin, Johnson, Wilson, and Young, 2013; Richardson, 1999). Previous experiences also have an impact on future expectations and motivation (Maddux and Galinsky, 2009). To increase students’ motivation to learn, their goals must be achievable and valuable (Gyurko, 2011). For physiotherapy students this could mean that the characteristics, values, and norms that they experience as desirable during their education affect expectations of their future profession. Previous studies have described physiotherapy students’ perception of the professional identity of their future profession in terms of patient interaction and their own professional learning within the profession (Engardt et al., 2006). This has been done through a more evidence-based approach, where the patient is treated; another approach, where the therapist teaches and works together with the patient; or a third alternative, where the therapists learn from and empower the patient (Engardt et al., 2006). Students’ picture of the profession develops throughout education, affected by their experiences of studying and the education program (Korpi, Peltokallio, and Piirainen, 2014). With support from educators, students’ awareness of professional competence also develops (Kurunsaari, Tynjälä, and Piirainen, 2018). To develop the physiotherapy curriculum and support the students throughout their education, it is important to understand what expectations students’ have regarding their future profession and the educational program, as these may influence learning (Illeris, 2009). Therefore, the purpose of this study is thus to describe first and final year physiotherapy students’ expectations of their future profession.

Method

Design and Participants

To describe students’ expectations, we used a qualitative design with manifest inductive content analysis of students’ written reflections about their future profession as a physiotherapist. By using the students’ written reflections, we expected to collect a variety of data.

A new curriculum was implemented and used at a Swedish Medical University from 2006 to 2014; therefore the study addressed presumptive respondents who were students in the first semester 2006, and last semester 2014. The registered students from each category were invited by e-mail to participate in the study – 75 students who were in their first semester and 110 students who were in their final semester. Forty-five students who were in their first semester (age: 19–48 years, mean 27.5 years; 68% women) and 51 students who were in their final semester (age: 22–54 years, mean 27.0 years; 68% women) agreed to participate.

The students received written and/or verbal information about the study including that it was voluntary to participate and how the data would be handled. Participants gave written informed consent to participate. The project was approved by the department at the university, within the Master’s Program. The study followed principles of the ethical framework for research on learning (Cousin, 2009) and the Declaration of Helsinki (World Medical Association, 2013).

Data Collection and Analysis

For both groups an approximately 1 page assignment written by the students within the physiotherapy program was used in the analysis. The students had to reflect on personal expectations of their future profession as physiotherapists – ‘how they wanted to act and work as a physiotherapist.’ This was a part of the usual course work for the first and final semesters of the physiotherapy education program.

All written reflections and demographic data were coded during the analysis procedure and handled confidentially when presented with the intention of mitigating any risk of the respondent being identified. The manifest analysis supported a lower level of interpretation (Graneheim, Lindgren, and Lundman, 2017). Data from each group were analyzed separately. Each reflection was read several times by one author, compared to the aim of the study, and compared to the other reflections in the group (Krippendorff, 2013). Meaning units describing the aim of the study were identified from each reflection and condensed to highlight their meaning. Each condensed unit was coded to clarify its content. The codes were then compared to identify similarities and differences and find categories that described the students’ reflections as a whole (Graneheim and Lundman, 2004). Categories, meaning units, and codes were continuously validated to the aim of the study, which resulted in new findings during the procedure (Elo and Kyngäs, 2008). Written reflections from the first semester were analyzed separately from written reflections completed during the final semester. The results were then compared, identifying similarities and differences. Finally, quotes were chosen that would concretize the categories to the reader and convey the students’ voices.

Two groups of researchers, each with one Master’s student, two senior lecturers and associate professors with extensive teaching and research experience in physiotherapy completed the data analysis. The Master’s students had experience as physiotherapy students and had supervised physiotherapy students and novice physiotherapists in clinical practice.

One Master’s student analyzed the first year students’ reflections, while the other analyzed those of the last year students. Each group worked systematically, and the data were analyzed individually by three of the researchers before a consensus discussion took place concerning the categories, which increased the trustworthiness and contributed with new interpretations of the data during the process (Graneheim, Lindgren, and Lundman, 2017). Consensus was found by focusing on the purpose of the study, the differences and similarities between the meaning units, codes, and categories that brought new perspectives, as well as the specific voices of the students.

Findings

The analysis resulted in six categories in both the first semester and last semester describing the students’ expectations of their future profession. The result is presented in Figure 1 and exemplified by quotations. At the end of this chapter there is a summary of the students from two semesters’ expectations.

Figure 1. Analytical categories derived from written reflection assignments by physiotherapy students in their first semester 2006 and by physiotherapy students in their last semester 2014.

The Findings from the First Semester of Year 2006

The categories were as follows: 1) Professional and person-centered; 2) Promote health in a holistic way; 3) Competence makes the patient and therapist feel confident; 4) Focus on education and behavioral change; 5) Confirmed as a role model; and 6) The impact of previous experiences and an unknown situation (Figure 1).

Professional and Person-Centered

The students wrote that it was important to see the person behind the patient and to ensure that the patient felt recognized, relaxed, safe, cared for, and confident that their well-being was being considered, as this would help them obtain the best possible treatment result. They expected the physiotherapist to be personal without being private and recognize the patient’s integrity, specific needs, and desires.

The students implied that the communication needs to be person-centered without preconceptions when diagnoses are set, yet with an awareness of how social, cultural, and ethnic backgrounds affect communication. Taking time to listen to each patient’s unique story with humility and empathy makes the therapist a good listener. It was expressed that open communication from the start instills trust in the patient relationship, where the therapist and the patient both have optimistic and realistic expectations.

I want to learn how to see and meet the person behind the visible problem/disability. [Sa3]

To be able to identify the patient’s problem and the goal of the treatment, the dialogue with the patient needs to be open and honest. [Sa4]

They described that patient participation was needed to set treatments goals, make the treatment effective, and affect the patient’s daily life. The patient should be active in the treatment, and the treatment goals should be realistic and achievable. Moreover, when needed, the treatment should include support from the patient’s family.

I want to work together with my patient to explore and piece together the puzzle that will make the most of the patient’s situation. [Sa7]

Promote Health in a Holistic Way

The students expressed that by using a holistic approach, physiotherapists could be aware of the interplay between physical and mental health, and wellness (i.e. being healthy or unhealthy). The students argued that the therapist must consider how psychological aspects affect the treatment results. The students perceived it to be essential for the professional role to promote health and provide health care and educate in wellness, such as physical exercise and good nutrition.

You can have pain somewhere that inhibits your ability to move, making you depressed. But it might also go in the opposite direction: you are depressed, not able to move and therefore in pain. [Sa17]

I want to promote health and work with prevention, in a long term perspective, and not just in health care. [Sa6]

Competence Makes the Patient and the Therapist Feel Confident

To be able to use evidence-based practice, physiotherapists must be aware of and critically appraise the latest research, the students declared; however, the physiotherapist should also be self-critical of their own way of working and not simply follow routines. The therapist should strive for post graduate education and preferably become a specialist in a certain field.

To use knowledge to convey confidence to the patient was something the students described in addition to having professional pride. The students implied that the physiotherapist needs to motivate the patient to accept the physiotherapists therapeutic skills and instill trust, making the patient feel safe by having a wide but also deep theoretical and practical knowledge base.

For the students to feel satisfied with their work, it is also important to have the skills to manage difficulties and any variation of what was necessary. They therefore requested to be challenged in their work and use all their knowledge to achieve the best treatment results, insisting they needed a solid knowledge base. The challenges would imply variation and stimulation in practice, as every patient’s situation is unique.

The students described that working in a team and professional network requires collaboration with other physiotherapists or other professions with different skills, and this in turn develops competence. By accessing professional networks, the physiotherapist can help the patient find the right treatment, the students suggested. It emerged that the students wanted to work in teams as well as independently, and the students also expressed that physiotherapists who worked in private practice could develop competences through network membership or by further education.

Finally, I know that within physiotherapy as well as in most other sciences, there is ongoing research to develop the methods of treatment and I want to be a part of progress to grow and be able to help the patients even more. [Sa1]

I want to give a feeling of security to the patient, so that the patient feels that he or she can rely on that I have good knowledge about both the body and the rehabilitation. [Sa2]

Each patient’s situation is unique, and therefore requires aunique solution. [Sa12]

I also wish to work in a team close to other professions to get the full picture of the individual’s problem, and in that way be able to help the client on different levels at the same time. [Sa14]

Focus on Education and Behavioral Change

The students wanted to support to life changes, which included instilling hope in the patient that he or she will maintain the lifestyle improvements. Students believed that if patients were coached to use therapeutic tools and their own resources over time, they would make small changes and increase their well-being and quality of life. They believed coaching patients to make life changes could put less strain on health care systems.

It emerged that the students found that motivating and teaching were important pedagogical skills used in treatment; they wanted to encourage patients to take responsibility for treatment. Students believed that interventions, such as physical activities, should be explained with a positive attitude and with a request that the patient follow the advice.

Helping patients to learn how to help themselves to be self-sufficient and independent. [Sa10]

I hope that I too will become a pedagogical physiotherapist who is good at informing patients, so they feel included. [Sa16]

Confirmed as a Role Model

The students believed that being needed and liked by the patient, and corroborating the treatment results and patients’ satisfaction, affirmed the physiotherapist’s work. It seemed important to the students to be a role model and live as you learn, and they wanted to inspire and support patients and colleagues to improve public health through their own lifestyle and professional interest.

I like to interact with people, and I want nothing more than to help those who have different kinds of problems, and if that is through lectures or during treatments doesn’t matter, just knowing that I have made a difference in another person’s life means so much. [Sa8]

To be the one that maybe inspires and contributes to somebody having an easier life. That would be cool. [Sa9]

The Impact of Previous Experiences and an Unknown Situation

It was shown that students wanted to combine previous professional experiences, such as nutrition advising, firefighting, and working with children or horses, with the physiotherapy profession. Most often it was a profession the students had before becoming physiotherapy students, but it could also be a special interest or a hobby that they wanted to combine with physiotherapy. The students described feeling confident using previous experiences and skills that they had already mastered in their new physiotherapy profession.

The students’ positive and negative experiences of health care, as well as those of their friends and families, affected how and with what patient groups students wanted to work with, and this inspired their ideas, desires, and dreams about their future profession. A previous sports career or experience of injuries evolved into an interest in sports medicine in fields like soccer, tennis or dance. Previous experience was also a way to stay in contact with a sport and its community. By working with specific patient groups, the work was meaningful and familiar to students. The choice of interventions could be based on the students’ experiences and familiarity with treatments, such as massage, trigger points therapy, horseback riding, dance, physical exercise, acupuncture, ergonomics, orthopedic manual therapy, and orthopedic medicine international. In the future profession, students felt they would choose where they worked based on their experiences, and with a deepened knowledge through physiotherapy. Students could also feel uncertain about which field of physiotherapy to work in, and even if the profession was the right choice for them. Some had certain ideas but were uncertain of the direction.

I enjoy working with children very much, and would like to continue doing that as aphysiotherapist. [Sa19]

Because I have a disabled brother, I’m also not opposed to working with physiotherapy for the disabled. [Sa10]

Right now, Idon't know where Iwant to work, everything feels just so new and confusing. [Sa20]

The Findings from the Final Semester of Year 2014

The categories from the study of the final semester were as follows: 1) Interaction and learning; 2) Confidence by competence; 3) Value the work environment and knowledge exchange; 4) Personal goals and strategies; 5) Specialist or generalist work; and 6) Work with public health in a global world (Figure 1).

Interaction and Learning

Students highlighted creating a good patient relationship by using a holistic perspective. Desirable characteristics for building relationships were being trustworthy and courteous, mediating hope and energy, and allowing time for the patient feel confirmed and motivated. Social competence and having an interest in humans were furthermore seen as vital, as well as being “on one’s best behaviour.” The students wanted to use their professional skills when they supported patients’ self-efficacy to increase health, and an awareness of “placebo effects” and how the patient’s expectations affected the treatment was also expressed. They wanted to build a personal patient relationship of trust and inspiration with an open, straightforward approach. To them, in their future vocation, the abilities of empathy, humbleness, and humanity would help to reach the patients. With a holistic perspective, and by taking part in the patients’ dreams and hopes, the students found that they could collaborate with the patient during treatments. They felt patients should feel unrestrained and that the appointment with the therapist was meaningful. By working like this, the students thought patients could be guided and motivated, from the crises of being a person in need, to the situation when they reached their own meaningful rehabilitation goals.

Students emphasized the treatment process as a source for knowledge by pedagogically making examination and treatment comprehensive to the patient. By combining physical and psychological interventions, the students considered that patients would find their own resources to increase health and strengthen self-efficacy. Moreover, an interaction between patient and therapist was expressed, where the physiotherapist strove to understand the patients’ attitudes, intentions, and experiences to reason through different alternatives and support the patient in making a decision.

Much in the physiotherapy profession is about motivating people in different ways. If we don’t have the patient on board, many of the interventions we do are not possible. I think that the key to get the patient motivated is mainly to earn trust and to do that, I think what I just mentioned above is of great importance – to be able to adjust your treatment and be aware and listen to the patient’s wishes. [Sb19]

My job is to make it as clear and understandable so that when I pass the baton to the patient, I also pass on the motivation and power to the patient to affect his or her own life. [Sb8]

Confidence by Competence

The students described that the know-how to investigate and treat was important, allowing them to use their acquired knowledge and skills to understand the patient’s problems and suggest effective, tailored treatments. Self-reliance in the professional role could be achieved by having and seeking new theoretical and clinical competences. In the patient relationship the students wanted to be seen as prepared, curious, and inspirational; a humble expert with humor, who has the patient’s consent to treat. By putting the patient’s needs first, the students believed that the patient would value the treatment with a mutual respect and integrity.

They also searched for a balance between their own private and working life. They accepted uncertainty within themselves in their early career, as well as a “good enough” attitude toward the demands in the independent profession.

(…) and I want to give a professional assessment based on the examination and what is possible to accomplish. [Sb38]

In my role as a physiotherapist, I want to be a person who is accommodating, someone the patient trusts, someone the patient listens to, someone who listens to the patient, someone who is perceived as very skilled, knowledgeable and professional. [Sb1]

Value the Work Environment and Knowledge Exchange

To give and receive support within a professional team for best treatment, and working together with the patient, were ways to gain the patient’s trust, as well as achieve positive treatment results. Students also felt they could achieve support within co-working health care organizations for best treatment by working with broad expertise and individual and holistic perspectives.

The students requested support from colleagues in their early work life. They wanted to learn from colleagues and other professionals, as well as be a resource of knowledge themselves. According to the students, collaboration at the work place and between different work places increases patient safety as well as competence.

Another thing I think is important is that you don’t think you can solve all problems by yourself. The patient might need to see another profession to receive the best treatment. That’s why I would like to work in place with different professions, and where teamwork is a common thread. [Sb36]

Being a part of and contributing to an encouraging work environment with jovial and proud colleagues, where everyone’s competence is used, makes for a healthy workplace. The students wanted to have a salary in accordance with their skills, time for education and knowledge exchange, as well as time for patient centered examinations in order to provide appropriate health care.

In the same way I want to be as a physiotherapist, I also want to work. I want to work in a place with good atmosphere and fellowship, I want to contribute to that myself by working in a way that includes and updates colleagues, by being flexible and responsive to experiences and suggestions of others, without being run over. It´s important for me to feel comfortable. [Sb48]

Personal Goals and Strategies

Strategies to obtain knowledge and evidence-based practice relied on experiences from work, education, and research. Lifelong learning, through transferring acquired experience and skills in new interactions, situations, and fields, was desirable. To grow and achieve personal professional goals was described as meaningful. Students wanted to gain work experience quickly to begin their new career as an independent physiotherapist and feel comfortable handling demands from patients and colleagues. Students looked forward to meeting challenges and reaching their goals (e.g. to develop their professional identity, have their own business, or find interesting fields to specialize and conduct research in).

I want to be a physiotherapist who is up to date. To always take part of and study new knowledge. To be able to act and treat in different ways based on new knowledge. [Sb18]

I would like to work as a physiotherapist for a few years to get a feeling for where I belong. Possibly specialize in an interesting field. When I feel I have gotten a few years of clinical experience and reached a point where I maybe feel content. Then I would consider doing research in an interesting field or become a teacher to share my knowledge and experience. [Sb33]

Specialist or Generalist Work

Specific professional roles for supporting the patient or other professionals were exemplified by the students. They wanted to combine different roles in different ways by, for example, being a coach, teacher, employer, consultant, entrepreneur, and clinician. Some students found combining academic work with clinical work attractive, as well as treating patients while being a supervisor/tutor for students.

The role I can think of having as a future physiotherapist includes treatment, coach and consultant, as I said it depends on the field where I find my niche. However, I think that I will change field a couple of times during my life to be able to try different sort of things. [Sb11]

To work in a specific field or in different fields were both of interest. Some students wanted, as a specialist, to work specifically with primary care, inpatient care, outpatient care, elderly care, and rehabilitation clinics, or within neurology and sport medicine. Other specific fields were pain treatment, psychosomatic treatment, education, promotion of health care, and sport medicine for children and adolescents. Others had a wider interest and wanted to try different fields (e.g. primary care, emergency, hospitals, outpatient care, elderly care, neurology, sport medicine, psychiatric care, and geriatric care). Other examples were group home care, promoting health, physical activity, ergonomics, pediatrics orientated toward medical aids, and treatments for stress, pain, obesity, and psychosomatic disorders.

The students also wanted to work with specific interventions or combinations for the examination and treatment of body and mind. They described interventions including motivational interviewing, manipulative treatments, patient schools, meditation, the McKenzie approach, and exercise, all individualized to the patient’s needs.

In addition, I think the approach that is used with treating psychosomatic patients is extremely interesting. It is a patient group I really want to work with in the future. To try to contribute to motivate patients, finding their resources and strengthen them is something I find very motivating. [Sb22]

I want to work within a practice where I see different patient groups with different levels of problems. In this practice, I want to investigate patients by manual examination, as I find this to be a great challenge. Regarding treatments, I hope to be able to use a variety, where I don’t get stuck on one type of treatment, exercises, etc. [Sb50]

Work with Public Health in a Global World

Among the reflections were thoughts about wanting to develop the profession to promote public health through research, but also by affecting primary schools for children, and society in general. Highlighted issues were equality, gender, and global perspectives. The students wanted to create a better world by using their profession in developmental work abroad and offering treatments to disadvantaged groups.

Students desired to be a part of a global labor market by working in different parts of the world. Working abroad would afford new experiences and increased knowledge, as well as an opportunity for volunteer work and research. More knowledge of entrepreneurship was important for students’ careers, which was considered lacking in the physiotherapy program. Students also acknowledged difficulties in finding a job due to their increased age and ethnic background, and a limited labor market.

To be able to work on developing the subject of Physical Education and Health at elementary school levels, or maybe even within the physiotherapy program would be really fun! [Sb33]

Another thought would be to travel abroad for a season to work as a physiotherapist in order to acquire new knowledge from a different culture. [Sb47]

Summary of the Two Semesters

In the first semester the students wanted to engage in person-centered work, with a holistic approach and focus on education and behavioral change. Competence made them feel confident, but they wanted to be confirmed as a role model and their previous experiences affected their view of their future profession. In the final semester the students focused on interaction and learning together with the patients; they moreover valued the work environment and knowledge exchange and felt confident with their competence. They had their personal goals and strategies and wanted to work with public health in a global world.

DISCUSSION

The purpose of this study is to describe first and final year physiotherapy students’ expectations for their future profession as physiotherapists. That is, to understand what values and norms students from different aspects of the physiotherapy program hold concerning the profession. The results showed among other things that students in their first semester referred to previous experiences and how that affected their expectations. On the other hand, students in their final semester developed strategies to achieve their professional goals. The results showed that the first semester is a time where professional work approaches seemed valuable to the students, such as working in a person-centered and holistic manner. While the final semester revealed an awareness, a professionalism, and there was also an awareness of future work conditions.

In our study, students referred in the beginning to their previous experiences in the category The impact of previous experiences and an unknown situation, which also contained their feeling of uncertainty about working as physiotherapists. However, in the final semester, the students were more certain about what they wanted to work with and how. In previous research it has been shown that physiotherapy students choose the profession because of their personal interests and experiences (Gotlib et al., 2012).

In the categories Professional and person-centered and Promote health in a holistic way concerning the students in the first semester, and the category Interaction and learning concerning the students in the last semester, all described the need to see the patient. Beginning students wanted to communicate their ideas for treatments, while the students in their final semester used skills to take part in the patient’s viewpoint and learn from the patient. Physiotherapy students’ professional identity has been presented as varying between empowering teaching and treating the patient (Engardt et al., 2006). Our results suggest that students in the final semester approach working as a physiotherapist in different ways, using different tools to achieve a person-centered focus. For this, critical reflection is of great importance. According to Kurunsaari, Tynjälä, and Piirainen (2018) it is vital to support physiotherapy students in reflecting, expanding their ability to reach each patient and understanding what is important from the patient’s point-of-view. To the patient, the therapist’s approach can be more important than the treatment results (Asay and Lambert, 1999).

The final semester students’ professional competence was exemplified in the category Competence Makes the Patient and the Therapist Feel Confident by not simply following routines but adapting their skills to each situation (Heiwe, Holdar, and Wallin, 2013; Kurunsaari, Piirainen, and Tynjälä, 2015; Richardson, 1999); this describes professionalism. Physiotherapists are challenged in clinical practice with new situations that will develop their competence (Knight, 2002), which was also something that the students longed for.

The difference between the category from the group in the first semester, Competence makes the patient and the therapist feel confident, and the category Confidence by competence from the group in the last semester, was that the latter group’s attention was toward the interaction with the patient instead of themselves. The first-semester students wanted competence to avoid feeling insecure in front of the patient. While the final-semester students accepted their insecurity and felt confident using their acquired competence to understand the patient’s situation. The students in the final semester had found concrete strategies for how to achieve their personal professional goals about how to work, and with what, how to develop their professional identity. The key, according to the students, was to instill trust within the patient. Through trust, the therapist can learn from the patient and the patient can learn from the therapist. A person’s ability to learn is affected by his or her urge to accomplish and understand what is to be learned and the specific context (Illeris, 2009).

Both the therapist and the patient must understand the purpose of their interaction. The students in our study reflected that when the patient is involved in, and understands, the treatment, this is the therapist’s responsibility (Trede, 2012). However, a superior clinical result should be possible, as described by research (Park et al., 2003). Helping patients understand the examination and therapy process and tailoring the treatment are as equally important as specific treatment techniques (Jensen, 2011). Students from the final semester also argued that verbal and non-verbal communication skills were needed (Black et al., 2010) as was constructing rehabilitation goals with the patient in a respectful and relaxed environment. Using rehabilitation goals is part of physiotherapy skills and treatment (World Physiotherapy, 2011b); an environment that supports the patient in expressing emotions is also important (Gard and Gyllensten, 2004). The students in their final semester accepted their own insecurity as new to the profession. They identified with the patient on a human level (Haslam, 2004) with mutual respect and had professional values (Aguilar, King, Scutter, and Stupans, 2013) such as empathy and respect, as seen in the category Confidence by competence.

The category Confirmed as a role model from the first semester, and the last semester’s Value the work environment and knowledge exchange, outlined the students’ desire to be needed. In the first semester, the students wanted to be confirmed as a good therapist and inspire the patient. In the final semester the students had desires for achievements within the profession, to take responsibility for their work environment, and a resource within a team. Physiotherapists are aware of their own professional role in the team and increase their self-reliance through clinical reasoning and social interaction (Black et al., 2010).

In both semesters, the students had different views of how and where they want to work, from the first semester’s Focus on education and behavioral change to the final semester’s Specialist or generalist work and Work with public health in a global world. That students in the final semester shared more examples of work fields and roles they found interesting and wanted to develop the profession within society and primary school, showed their professionalism in using their competence within the profession (Richardson, 1999). The students in the beginning of the program described themselves as uncertain because they were becoming increasingly aware of the many possibilities within the profession. In contrast, students in the final semester felt unsure about finding a job. Another concern was having time to provide effective and safe treatments. These concerns seemed less achievable for the final students and should therefore be addressed by teachers and supervisors mutually to strengthen the connection between theory and practice (Heggen and Terum, 2013). Students in our study requested competence in entrepreneurship and time for their professional development, which is part of their professional development (World Physiotherapy, 2022). Physiotherapists as first-contact practitioners can be the first to approach the patient’s situation and need a wide and strong knowledge base (Gotlib et al., 2012). Some physiotherapists fear having insufficient knowledge (Boström et al., 2013). It is therefore interesting that students in their final semester had strategies for their future professional development. They saw the patient and the team as a knowledge and learning resource (Gotlib et al., 2012; Park et al., 2003).

It is essential that students’ expectations are known by educators, so that educators can support and motivate students to develop within the profession. The students’ expectations can be used to facilitate professional development and motivation and guide curriculum development (Korpi, Peltokallio, and Piirainen, 2014). Further research is needed to answer how the physiotherapy program can influence the students’ expectations of their future profession and how teachers and supervisors observe and reflect on students’ perceived values during the program.

Strengths and Limitations

Students from the first and final semester of the physiotherapy program were included in the present study. However, we did not follow the same group of students longitudinally, which might have influenced the results. Two separate study samples, eight years apart, imply different individuals with their respective attributes, as well as changes in society and the health care context concerning cost-effectiveness, technical development, and person-centered interventions, all of which influence the students view of themselves and their role as physiotherapists (Fagerström, Tuvesson, Axelsson, and Nilsson, 2017). However, the curriculum was the same from 2006 until 2014, although the specific course syllabuses were constantly developed.

Written reflections are used to bring a deeper understanding of a situation (Cowin, Johnson, Wilson, and Young, 2013; Trollope-Kumar and Wong, 2014). The open questions in the written assignment gave the students freedom to describe their expectations, dreams, and plans concerning their future profession. The exercise was not anonymous, although the material was handled confidentially. It is unclear how the lack anonymity might have affected the students’ reflections. To use focus groups or individual interviews would have included reflections from fewer students and may also have made it difficult to capture key personal reflections, although follow-up questions could have enhanced an even deeper understanding.

There were varying levels of experience with content analysis in the research group. Therefore, the group strived for transparency within the analysis. The researchers’ preunderstanding will inevitably affect the result (Graneheim, Lindgren, and Lundman, 2017) which in this study consisted of supporting students’ expectations in their professional development as physiotherapists. Through the analysis the group discussed, tried, and retried the material several times to highlight, compare, and estimate the meaning units, codes, and categories concerning the aim of the study to increase trustworthiness. Moreover, throughout the process new insights were made (Graneheim and Lundman, 2004) where the quotes from the reflections added trustworthiness to the results (Malterud, 2001).

CONCLUSION

Students in their first semester described different work approaches and referred more to previous experiences. They wanted to be a role model and motivate the patient. Students in their final semester describe how different ways of working were used and that they wanted to give and receive support, and they developed strategies to achieve their personal professional goals. In their final semester, students were concerned about their future work environment, but felt confident in their professional competence. These findings might contribute to guide students' in their continuous professional development based on their experiences and expectations. Further research should investigate whether students’ expectations meet their future profession and working life and what kind of support they need.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.